Table 1.
Bile duct substitute using autologous tissue
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Ref.
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Journal
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Substitute (n)
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Stent (n)
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Animal type (n)
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Size of BDS (cm)
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Method of reconstruction of bile duct by BDS (n)
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Observation period after implantation
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Localization of regenerated bile duct
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Causes of stenosis
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Note (planned sacrificial death and epithelialization)
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| Shea and Hubay[15], 1948 | Ann Surg | Femoral vein (21) | Vitallium tube | Dog (21) | Ring (1.5) | CBC (21) | Maximum 208 d | BDS itself | Necrosis of BDS itself, narrowing of the BDS lumen, and narrowing of the anastomosis with the native bile duct | Although 14 out of 21 dogs were intentionally killed, the tissue of the regenerated bile duct was shown only as a result, and the process of bile duct regeneration was not demonstrated |
| Kirby and Fitts[16], 1950 | Arch Surg (1920) | Jejunum (9) | T-tube | Dog (9) | Jejunum (2.5) | GBC (5); CBC (4) | Maximum 13 mo | BDS itself | BDS stenosis was not observed when the T-tube was inserted | Seven out of nine dogs were intentionally killed; however, no epithelial regeneration was observed at the anastomotic site. The procedure was too complicated |
| Pearce et al[10], 1951 | Ann Surg | Femoral vein (32) | Lord and blakemore tube | Dog (32) | Ring (1.0) | CBC (10); CBJ (20); GBC (2) | Maximum 6 mo | BDS itself | Necrosis of autologous tissue, narrowing of the lumen of autologous tissue, narrowing of the anastomosis with the native bile duct, necrosis of BDS itself, narrowing of the BDS lumen, and narrowing of the anastomosis with the native bile duct | Only 1 of the 32 dogs survived for more than 6 mo. It was investigated in 32 dogs; however, in the end, fibrosis of the vein and stenosis of the anastomotic site with the native site occurred, and bile duct epithelial regeneration was not observed. It was concluded that the vein was not suitable for BDS |
| Ulin et al[17], 1955 | Ann Surg | Vascularised jugular vein (10) | Polyethylene tube | Dog (10) | Ring (2.0-5.0) | CBC (10) | Maximum 10 mo | BDS itself | Necrosis of autologous tissue, narrowing of the lumen of autologous tissue, narrowing of the anastomosis with the native bile duct, necrosis of BDS itself, narrowing of the lumen of BDS, and narrowing of the anastomosis with the native bile duct | The omentum was used to maintain blood flow to the BDS, but in some cases, it functioned as a BDS only during the period when the stent was in place (6 out of 10 dogs). Bile duct regeneration process was not studied. No regeneration of the bile duct epithelium was observed |
| Myers et al[18], 1960 | Ann Surg | Femoral vein and artery, bile duct (17), and homologous bile duct (6) | Polyethylene tube | Dog (28) | Ring (unknown) | CBC (23) | Maximum 449 d | BDS itself | Necrosis of autologous tissue, narrowing of the lumen of autologous tissue, narrowing of the anastomosis with the native bile duct, necrosis of BDS itself, narrowing of the BDS lumen, and narrowing of the anastomosis with the native bile duct | BDS using autologous veins, arteries, or allogeneic arteries also narrowed shortly after transplantation. No bile duct epithelial regeneration was observed |
| Dunphy and Stephens[19], 1962 | Ann Surg | Autologous vein and artery (20), and homologous artery (32) | T-tube | Goat (44), dog (8) | Ring (1.0) | CBC (52) | Maximum 9 mo | BDS itself | Necrosis of autologous tissue, narrowing of the lumen of autologous tissue, narrowing of the anastomosis with the native bile duct, necrosis of BDS itself, narrowing of the BDS lumen, and narrowing of the anastomosis with the native bile duct | In an experiment using autologous veins and T-tube as BDS, 2 dogs survived for more than 6 mo; however, both dogs demonstrated dilation of the bile duct on the liver side. No bile duct epithelial regeneration was observed |
| Belzer et al[44], 1965 | Ann Surg | Femoral vein (20) | T-tube | Goat (20) | Patch (3.0-4.0) | Patch (20) | Maximum 11 mo | BDS itself | Necrosis of autologous tissue, narrowing of the lumen of autologous tissue, narrowing of the anastomosis with the native bile duct, necrosis of BDS itself, narrowing of the BDS lumen, and narrowing of the anastomosis with the native bile duct | Only 3 out of 20 dogs were intentionally killed, but no good bile duct epithelial regeneration was observed |
| Lindenauer and Child[47], 1966 | Ann Surg | Vascularized jugular vein (14) | (-) | Dog (14) | Ring (unknown) | CBC (14) | Maximum 18 mo | BDS itself | The omentum increased blood flow to the BDS; however, it resulted in scar contraction. Necrosis of BDS itself, narrowing of the BDS lumen, and narrowing of the anastomosis with the native bile duct | No dog survived for more than 3.5 mo, although the omentum was used to maintain BDS blood flow |
| Palmes et al[48], 2009 | J Invest Surg | External jugular vein (18) | PLA stent (12) | Pig (18) | Ring (2.0) | CBC (18) | Maximum 6 mo | BDS itself | When the stent was not inserted, the BDS was necrotic. When the stent was inserted, the BDS lumen was preserved, but eventually, it became necrotic and narrowed | Of the 18 dogs, all 12 stented dogs were deliberately killed. However, the process of regeneration of veins into the bile duct was not reported |
| Liang et al[49], 2012 | World J Gastroenterol | Omentum (8) | Bioabsorbable stent | Pig (8) | Ring (0.5-1.0) | CBC (8) | Maximum 4 mo | BDS itself | The BDS lumen was preserved when the stent was inserted | The bile duct defect was repaired with an omentum, which was similar to inserting a T-tube into the defect. Bile duct regeneration was also poorly demonstrated |
BDS: Bile duct substitute; CBC: Common bile duct to bile duct substitute to common bile duct; CBJ: Common bile duct to bile duct substitute to jejunum; GBC: Gallbladder to bile duct substitute to common bile duct; PLA: Polylactide acid.